developing a compassion-based therapy for trauma-related shame and posttraumatic stress teresa m....
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Developing a Compassion-Based Therapy for Trauma-Related Shame
and Posttraumatic Stress
Teresa M. Au, M.A. 1, 2
Brett T. Litz, Ph.D. 1, 2, 3
ACBS 2014June 19, 2014
1 VA Boston Healthcare System2 Boston University Department of Psychology3 Massachusetts Veterans Epidemiological Research and Information Center (MAVERIC)
Disclaimer: This work does not necessarily reflect the opinion of Boston University, VABHS, or MAVERIC
Today’s Agenda
• Background on shame and compassion
• Description of 6-session intervention
• Study design
• Preliminary data
Shame and Trauma
(Gilbert et al., 2006; Dorahy, 2010; Harman & Lee, 2010; Lewis, 1971; Vidal & Petrak, 2007)
• Shame = the emotion evoked when engaging in a
global, negative self-evaluation (i.e., feeling
fundamentally bad, inadequate, worthless)
• Shame associated with:
• Development and maintainence of PTSD
What is compassion?
“A sensitivity to the suffering of self and others with a deep commitment to try to relieve it” (Lama, 2001)
3 components of self-compassion (Neff, 2003)
• Awareness of suffering (mindfulness)
• Viewing one’s own shortcomings and suffering as part of the larger human condition (common humanity)
• Responding to suffering with warmth and understanding (kindness)
Compassion vs Mindfulness
• Mindfulness: nonjudgmental, present-centered awareness of experience
• Compassion: responding to the experiencer of suffering with kindness, warmth, acceptance
(Germer & Neff, in press)
Compassion InterventionsCompassion Focused Therapy (CFT) - GilbertMindful Self-Compassion (MSC) - Neff & GermerCompassion Cultivation Training (CCT) – Jazaeri et al.
(Gilbert & Procter, 2006; Mayhew & Gilbert, 2009; Jazaieri et al., 2012; Neff & Germer, 2012)
Promising Results:• self-compassion, compassion for others• life satisfaction, social connectedness• shame, depression, anxiety, avoidance
Limitations: • Non-clinical populations• Not yet systematically evaluated for treating
trauma-related shame and posttraumatic stress
Primary Study Aims
1. Develop a brief compassion-based intervention for reducing shame and PTSD symptoms.
2. Evaluate its feasibility, tolerability, and efficacy.
3. Examine whether changes in shame and PTSD symptoms are associated with changes in self-compassion.
Overview of 6-Week Treatment
• 6 individual therapy sessions• Emphasis on experiential exercises
(Adapted from CFT, MSC)
Weeks 1-3:
Practice self-compassion for everyday difficulties
Weeks 4-6:
Practice self-compassion in response to trauma memory
Session 1Goals:• Provide information on PTSD and common trauma reactions• Provide basic instruction on mindfulness and grounding
techniques
Session Topics:• Common reactions to trauma (including shame, PTSD)• Introduction to mindfulness
Experiential Exercises:• Mindful breathing• Mindful observing of the here-and-now (i.e., grounding)
Practice assignment:• Practice mindful breathing and grounding daily
Session 2Goals:• Build motivation to reduce self-criticism and increase compassion• Address fear of self-compassion • Begin practicing self-compassion for everyday difficulties
Session Topics:• 3 emotion regulation systems (Gilbert, 2010)
• Identify fears and misconceptions about self-compassion (Lee, 2013)
• Use story of “Critical Coach A and Compassionate Coach B” to explore myths about compassion (Otto, 2000)
Experiential Exercise:• 3 parts of self-compassion (“Self-Compassion Break”) (Neff & Germer, 2012)
Practice assignment:• Identify any fears of self-compassion, list reasons for becoming
more self-compassionate• Practice self-compassion break for everyday difficulties• Write compassionate letter to self
Session 3Goals:• Continue practicing self-compassion for everyday difficulties• Begin creating a felt-sense of compassion by engaging the senses
(smell, imagery, sensation)
Session Topics:• Picking a compassionate scent (Lee, 2013)
Experiential Exercises:• Sending Compassion (similar to Loving Kindness) (Neff & Germer, 2012)
• Perfect Nurturer (Compassionate Image) (Lee, 2013)
Practice assignment:• Use compassionate scent• Practice Sending Compassion exercise• Practice Perfect Nurturer exercise
Session 4Goals:• Begin to access the trauma memory and practice self-
compassionate response to the memory
Session Topics:• Identify trauma “hotspot” (peak moment of distress)
Experiential Exercises:• Facing the traumatic event with the perfect nurturer
(Lee, 2013)
Practice assignment:• Practice facing the traumatic event with the perfect
nurturer
Session 5Goals:• Continue practicing self-compassion in response to
trauma-related difficulties
Session Topics:• Identifying strong trauma-related emotions and typical
reactions (i.e., avoidance, resistance)
Experiential Exercises:• Compassion Antidote (soften-allow-soothe)
+ Savoring Compassion (Neff & Germer, 2012; Lee, 2013)
Practice assignment:• Practice Compassion Antidote• Write 2nd self-compassion letter: Bringing compassion
to your trauma story
Session 6Goals:• Review skills learned• Make commitment to practicing compassion in
response to trauma-related difficulties
Session Topics:• What will you take with you, and how will you
remember?
Experiential Exercises:• Brief exercise of the participant’s choosing
Practice assignment:• Continued independent practice
Study Design: Multiple Baseline• N = 9
• 3 phases:
• Pre-Treatment: Randomized to 2-, 4-, or 6-wk baseline.
• 6 wk treatment
• 4-wk follow-up
• Each participant is his/her own control
• Everyone receives the intervention.
• Time- and cost-effective for testing novel treatments
Study Design: Multiple Baseline• N = 9
• 3 phases:
• Pre-Treatment: Randomized to 2-, 4-, or 6-wk baseline.
• 6 wk treatment
• 4-wk follow-up
• Each participant is his/her own control
• Everyone receives the intervention.
• Time- and cost-effective for testing novel treatments
Preliminary Results from Multiple Baseline Study
• Female participant in her 20’s• Drugged at party and raped 6 years ago
Summary
• Novel treatments needed to directly address shame and self-blame after trauma
• Our study evalutes a 6-week compassion-based therapy for reducing trauma-related shame and posttraumatic stress. Preliminary results and feedback from pilot testing are promising.
• Multiple-baseline can be a cost-effective and efficient method for evaluating novel treatments.